July 15, 2014

Expectations [2]

Continuation from previous post: Tagging and Expectations [1]

  • Weekends, day-off and time to eat and sleep: Housemen do NOT have weekends. Full-Stop. We’re doing shift system so our day-off might fall on weekdays or weekends. Different hospital and department have different shift depending on the number of houseman and patients. So do NOT expect to have weekends. Unable to eat lunch at lunch time is NORMAL. Worse come to worst, sometimes we have to jamak our solat because of short of time.

    My first 2 weeks of tagging in O&G as first posting, my lunch and dinner was at 10.30 or 11 p.m. and I had to qada’ Maghrib and sometimes Zuhur and Asar during Isyak; that on top of my families were 300+ kms away from where I chose to work and I got home with sore foot because of standing too much. I lost 10 kgs and had only on average 4 hours of sleep during my medical posting.

    Over the time, you will learn when to eat, how to get enough rest and at the same time enjoying your work. Learn surviving skills. Do not compare your job with ‘office-hour’ jobs.

    A great teacher once reminded our batch this: Toughen up during housemanship; even when you're tired or completely knocked down, just don't complaint. Do your best, make sure to give it all you've got in these 2 years. Don't be calculative (exact words were 'jangan berkira sangat') with your colleagues, cover for them, have good teamwork!
    I live by this mantra during my first few months as a house officer.
  • We don’t expect you to be a genius who can come up with correct diagnosis on the spot BUT we need you to be functional, reliable and safe houseman. Learn what are stable cases and what are red-alert cases, what are important signs and symptoms or urgent/red cases that MO and specialist need to see urgently- you are the first liners, you see the patients first when they come to ward or in PAC so you need to be the eyes that filter things. Learn to prioritise your work- what needs to be done first, i.e. if you need to refer a case to respective department urgently, or you need to go and request for ultrasound or CT-brain, or if you need to quickly attend a patient who collapsed first. 
  • Have common sense. This is related to point above.
  • Learn surviving skills: Do a little homework about the department that you are about to enter- knows the requirement of that posting, get to know how the MOs and specialists are and how to ‘tackle’ them, learn which staff who will be able to help you out, fill in your logbooks early and with consistency, learn how and when to fill in your SKT and CPD and declare tax and so forth.
      
  • Knows your limitation and yourself: If you don’t know, ask. If you are not confident in doing procedure, practice and ask your senior colleagues to teach you. If you know that you take a long time to review patients, come earlier to make up for the time you need.

    During my medical posting, MOs come to do round at 8 a.m., so all patients needed to be reviewed and take investigations before they come, so being in-charged in one cubicle, I came around 5 – 5.30 a.m. just to make sure things are done before MOs and specialists came.

    If you see cases that you don’t know about, read up. Learning doesn’t stop when you graduate. You will feel that the more cases you see, the ‘dumber’ you feel. Learn from your mistakes. Learn how to de-stress and cope with stress. Work smart.

    I generally take 6 months to adapt so only during the later part of my second posting was I able to actually enjoy working as a doctor.
  • To be scolded is NORMAL during housemanship: We don’t scold you for no reason. Learn from mistakes. IF you still don’t know what you did wrong, ASK. We expect you to learn fast; we don’t care from which university you came from or if you’re a Dean’s List or Mumtaz students but we DO CARE for you to be functional. If we order investigations in the morning, of course we expect to see the results by afternoon round. If we ask to refer STAT or take blood and send STAT of course we expect it to be done urgently. If a patients need close monitoring and be informed if deteriorates, of course we expect to be called if patients collapsed. If we ask you about the disease and you don’t know, read up and if we ask you to read up, do read up and be expected to be asked again in the future AND be able to answer.

    Kena marah tu benda biasa masa houseman- ambil ape yang baik, and belajar dari situ; benda tak baik tu masuk telinga kanan, keluar telinga kiri- this is what I usually tell my junior colleagues.

    This is where your support system comes- have friends or colleagues, who share the same interest or are in the same boat to rant and ‘luahkan perasaan’, go to gym, go see movies, go eat, read Quran, seek comfort from families- pendek cerita, know how to de-stress and learn how to cope with stress.

    Reciting Quran and solat sunat was a way to calm myself down during tagging. Later, I found friends to hang with and we actually formed ‘Geng Makan2’ who’d eat out together after work and went bowling and watched movies.
  • Give a good first impression: Contrary to the saying ‘don’t judge a book by it’s cover’, first impression DO COUNT. People talk and people observe. Words about how good or how bad you are as a house officer might travel around especially in a small hospital, so yes, do give good impression and have the right attitude towards everyone.

In conclusion, at the end of the day, you are expected to be functional, responsible, reliable and safe houseman. Medical profession is tough and tiring and stressful. You may not be able to eat properly, sleep properly and yet are expected to function normally. So at the end of the day, correct your intention and remind yourself why you choose to be a doctor and what can motivate you to stay in the field?

IMAM/PPIM ( IMAM Malaysia ) organizes Houseman Preparatory Course at regular interval and they have fb group. Prepare yourself mentally. If you are reading this as a student overseas, when you’re doing attachment at local hospital during your clinical year time, observe how patients are, try to clerk cases, attach yourself with the HO and explore the job the scope, follow rounds and see how they present, ask if you can observe or do some simple procedure. Have a feel of how working in Malaysia is.

It also helps to have goals too. While you’re doing your housemanship, explore your interest: medical-based or surgical-based? Or are you interested in admin job, or lab jobs or teaching jobs? Find out various ways to do specialty programmes. IMAM also has Post-Graduate Preparatory Course every year. Learn as much during housemanship, because once you enter MO-ship, you will be accountable for every decision and management you make.

And while it is scary to embark into medical world, it is fun! To be honest, there’s no other job that gives this kind of satisfaction when patients you treat improve greatly and when they say thank you. It also reminds you how small you are and how humble you are and how great His plan is.

Wallahualam bissawab.